Inpatient insulin pen use yields patient satisfaction

Health center is now a 'pen hospital'

Researchers at Creighton University Medical Center and the School of Pharmacy and Health Professions have found that using prefilled disposable insulin pens rather than conventional vials and syringes in hospitalized diabetic patients led to greater patient satisfaction and cost savings.

Pharmacy professor Estella Davis, PharmD, tells Drug Formulary Review researchers conducted a prospective, randomized, controlled pilot study to evaluate the insulin pens compared to the conventional vial and syringe method in patients with diabetes reliant upon subcutaneous insulin injections during hospitalization on two medical-surgical units. All patients were followed to determine the extent of glucose control while hospitalized. They also completed a survey before discharge on their satisfaction with whatever method of insulin delivery they received and were given a telephone survey about four weeks after discharge to determine home insulin use.

Cost savings were determined based on the average wholesale price of both the insulin pens and the insulin vials and syringes.

In the study, which will be published in Diabetes in 2008, 75 patients were enrolled in the two groups, with 35 patients in the study group using the insulin pens and 40 in the control group using conventional vials and syringes. Davis reports there were no significant differences between admit and discharge blood glucose levels or hypoglycemic and hyperglycemic events between the two groups.

Significantly more patients prepared their own dose of insulin as well as self-injected their dose using insulin pens during hospitalization. Patients in the insulin pen group were significantly more satisfied with multiple aspects of their insulin experience during their hospitalization, and a significant savings of $40 per patient was found when insulin pens were used during the entire hospital stay compared with the conventional method. A significantly higher percentage of patients in the insulin pen group continued to use the pens at home, compared with the conventional method.

Both groups satisfied

Davis tells Drug Formulary Review that while both groups were very positive in reporting their satisfaction with insulin administration, more patients in the insulin pen study group agreed with survey questions that it was a good experience. She says one reason patients like the insulin pens was their ease of use. They were found to be convenient and simple and easy to use, she says, and lent themselves to continued use at home after patients were discharged from the hospital. Patients said they were confident in the dose level they were receiving and would recommend the method to others with diabetes.

Using the average wholesale price for both types of supplies and calculating the number of units used in a patient's hospital stay, researchers projected an average cost of $108 for those in the conventional vial and syringe group and $68 for those using insulin pens, for a savings of $40 per insulin pen patient.

Davis says that as a result of the research's findings, Creighton "is now a 'pen hospital.'" She says use of insulin pens is house-wide through the university medical center as well as in its other system facilities.

Asked what factors led to the project's success, Davis cited communication with the nurse diabetes educators on staff and having a pharmacist champion. She stresses the importance of adequate training for staff in terms of how the pens work, their shelf life, and how they should be labeled.

Their presentation was put in a poster format from the nursing perspective, she says, and there was a lot of buy-in for working toward the same goal. In addition, the infection control staff was brought in given the possibility for reduced needle sticks.

[Editor's note: Contact Dr. Davis at (402) 398-5646 or e-mail estelladavis@creighton.edu.]